We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Lead Director, Provider Claims Experience will develop and maintain a comprehensive process to support provider claims escalations from across a diverse and varied array of health system partners. This role will be critical in reconciling across approaches including Network Escalation Forms (NEF), spreadsheet exchange, email inquiries and related complaints and outreach to design a consistent process for intake, disciplined triage, and timely resolution through established SLAs. This role establishes effective working partnership with Network relations leadership, serving to consult / advise on targeted claims issues across a wide spectrum of root cause drivers (contractual, policy, workflow, etc.). The individual will be responsible for designing necessary workflows including but not limited to: approved templates and formats for submission, program guardrails and criteria, and where needed, collaboration / intersection with relevant cross-functional workflows and business units (e.g., rework, appeals). This individual has responsibility for leading a team of provider support roles with claims knowledge and experience to drive timely, accurate resolution of claims issues for Standard and select non-participating providers supported by a dedicated Provider Services / Network Market representative.  

Key Responsibilities

• Define and maintain a single, consistent intake-to-closure workflow for Standard (and select non-participating) provider claims escalations
• Design and operationalize standardized submission methods and minimum data requirements across channels, including NEF, spreadsheet exchange, and email inquiries.
• Create and maintain approved templates, forms, and guidance for submission to reduce inconsistencies and improve data quality
• Partner with Network relations leadership to align intake expectations with provider-facing communication
• Lead, coach, and develop a team of provider support roles with strong claims knowledge to deliver timely, accurate resolutions.
• Set clear expectations, role clarity, and performance standards; drive accountability while maintaining a sustainable operating rhythm.
• Lead change management for new process adoption (training, comms, reinforcement, feedback loops).
• Create mechanisms for listening to internal and external partner feedback and translating it into process improvements.
• Stand up and maintain queue management routines (daily/weekly) to ensure aging control, workload balancing, and timely follow-through.
• Provide consultative input on emerging claims trends and provider friction points observed through escalation volume, in partnership with broader Escalated Claim Issue Review leadership
• Maintain alignment to shared workflows across ECIR team including root cause tagging and definitions, reporting, turnaround time / quality performance, etc.

Required Qualifications

• 5-7 years of experience in Provider / Network relations and operations
• 3-5 years of experience in strategic initiative support & planning
• Prior experience leading cross-functional operational workflows with SLAs
• Strong written and verbal communication skills
• Ability to drive accountability across multiple stakeholders and resolve dependencies in a high-urgency environment

Education

Bachelor’s degree or equivalent work experience

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 05/02/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.